Our Senior Care
Menu

Unraveling the Mysteries and Uncovering the Facts about Long Term Care

January 27, 2025

Especially if you have a older loved with various health care needs, you’ve likely heard this term many times. But exactly what does it mean and how can you pay for it? LTC may seem like a simple term, but it actually is complex and involves many settings and services. Generally, LTC involves an array of services designed to meet the medical and non-medical needs of people with chronic illnesses, disabilities, and issues related to accidents or injuries who can’t care for themselves and safely remain independent. While most people requiring long term care are older (over 75), a growing number of younger people need these services because of accidents, mental illness, or substance abuse.

Here are 10 things you need to know about LTC to help unravel the mystery.

  1. Long term care includes an array of services to address someone’s health and/or personal care needs. When people can no longer perform various Activities of Daily Living (ADLs), they can no longer live independently. These ADLs include things like bathing, dressing, toileting, grooming, eating, and transferring (such as getting out of bed or up from a chair). Long term care provides help with ADLs and well as things like medication administration, dressing and cleaning wounds, and care for illnesses and conditions such as Alzheimer’s disease, COPD, heart disease, Parkinson’s disease, arthritis, and diabetes.
  2. Long term care means more than nursing homes. While most people think of nursing homes when they talk about long term care, LTC actually can be provided in many settings, including assisted living facilities, continuing care retirement communities, rehabilitation facilities, memory care units, hospitals, adult day care centers, and at home in the community. “Long term care really is a continuum, and the right setting for each person is based on the severity [acuity] of their medical problems and the types of care and services they need,” said David Smith, MD, CMD, president of Geriatric Consultants in Brownwood, Texas.
  3. Not everyone who is admitted to a long term care facility is there for the rest of their lives. Many people only stay in LTC facilities for a short period of time for things like rehabilitation after knee or hip surgery, a stroke or heart attack, or car accident. These individuals often are able to return to their homes when they recover enough to care for themselves independently or with the help of family or professional caregivers. LTC generally involves 3 levels of care: skilled care (24/7 care to treat a medical condition or illness), intermediate care (rehab and other services), and custodial care (such as help with ADLs).
  4. Medicare doesn’t pay for LTC. Contrary to popular belief, Medicare doesn’t pay for long term care. While it may pay for some services you receive in a nursing home (such as preventive things like a flu shot, the cost of physical therapy, or some diagnostic tests), it doesn’t cover your nursing home stay or stay in any other long-term care facility. It is important to know the difference between Medicare and Medicaid. Medicare is the federal health care insurance program that most people get when they turn 65 (or older). It covers basics such as hospital care, doctor’s visits, and preventive interventions such as immunizations. Medicaid is a federal-state partnership program that gives health care coverage to older adults and others with limited income/resources.
  5. Medicaid covers long term care, but there are limitations. The qualify for Medicaid coverage, you must meet your state’s financial eligibility and other requirements. Medicaid coverage is based on need, so you can’t have an annual income over a certain amount ($2,742 in 2023), and there are asset limits as well. If you have too many assets to qualify for coverage, Medicaid will reduce your assets via a process known as “spending down.” This means your assets are liquidated until you qualify. Note that while this sounds scary, some of your assets are protected, such as your primary home of residence and your car. It is important to note that while Medicaid programs are required to cover skilled nursing home care, they may not pay for custodial care or other aspects of assisted living, home care, or other settings. It is important to find out what is covered and what you will have to pay for out-of-pocket before your loved one moves into a facility.
  6. Long term care insurance may help, but you need to plan ahead. LTC insurance can help pay for long term care. It generally covers things like home health care and some nursing home and assisted living expenses, as well as respite care. Policies vary greatly in terms of what they cover, so it is important to know what you are getting before you sign up. Of course, the younger you are when you get a policy, the lower the premiums will be; and if your loved one is 65 or older, it may not be possible to get covered at an affordable rate if at all.
  7. Rehab (physical, occupational, speech/language/hearing) services are a key part of long term care. These services must be ordered by the physician or other clinician, but they generally are covered by insurance. However, it will be important to work with the care team to identify realistic goals of treatment.
  8. Hospice is part of long-term care. This is the care of those with a life expectancy of less than six months and have a qualifying diagnosis (such as cancer or Alzheimer’s disease). The good news is that Medicare has a hospice benefit that pays for various medical, social, emotional, and spiritual services including comfort care in a person’s last days, weeks, or even months of life.
  9. Different settings offer different services. While most long term care settings provide some basic services such as medication administration and monthly medication regimen reviews, dietary support, and physical and other forms of therapy, not every LTC facility offers the same services or has the same kinds of staff (for example, some require a 24/7 RN and some have a physician medical director as a clinical leader).
  10. Long term care attends to residents’ quality of life as well as their physical health care. “Long term care facilities tend to the whole person and address their physical, emotional, mental, and spiritual health. They also present people with opportunities to socialize and engage in activities and hobbies they enjoy,” said Smith. There is a focus on person-centered care, which customizes interventions and activities to each person’s needs, interests, likes and dislikes, and goals of care. The care team will work with you and your loved one to create a realistic care plan to help meet care goals and achieve the best possible outcomes and wellbeing.